Agenda Item 5 1 LINCOLNSHIRE HEALTH AND WELLBEING BOARD PRESENT: COUNCILLOR MRS S WOOLLEY (CHAIRMAN) Lincolnshire County Council: Councillors C N Worth (Executive Councillor Culture and Emergency Services), Mrs W Bowkett, R L Foulkes, C E H Marfleet, C R Oxby and N H Pepper Lincolnshire County Council Officers: Professor Derek Ward (Director of Public Health) and Sally Savage (Chief Commissioning Officer) District Council: Councillor Donald Nannestad (District Council) GP Commissioning Group: Dr Sunil Hindocha (Lincolnshire West CCG), Dr Kevin Hill (South Lincolnshire CCG and South West Lincolnshire CCG) and Dr Stephen Baird (Lincolnshire East CCG) Healthwatch Lincolnshire: Sarah Fletcher Lincolnshire Police and Crime Commissioner: Stuart Tweedale (Deputy Police and Crime Commissioner) Lincolnshire Coordinating Board: Elaine Baylis Officers In Attendance: : Andrea Brown (Democratic Services Officer) (Democratic Services), Alison Christie (Programme Manager, Health and Wellbeing Board), Steve Houchin (Head of Finance (Adult Care)), Lisa Loy (Housing for Independence (HfI) Programme Manager) and David Stacey (Programme Manager, Public Health) 27 APOLOGIES FOR ABSENCE/REPLACEMENT MEMBERS Apologies for absence were received from Councillor Mrs P A Bradwell, Glen Garrod (Executive Director of Adult Care and Community Wellbeing), Jim Heys (NHS England), Debbie Barnes (Executive Director of Children's Services) and Marc Jones (Police and Crime Commissioner). It was noted that Sally Savage (Chief Commissioning Officer Children's Services) and Stuart Tweedale (Deputy Police and Crime Commissioner) were attending the meeting on behalf of Debbie Barnes and Marc Jones, respectively, for this meeting only. Page 5
2 28 DECLARATIONS OF MEMBERS' INTEREST Elaine Baylis asked the Board to note that she was also the Chair of the Lincolnshire Community Health Services NHS Trust Board; Interim Chair of the United Lincolnshire Hospitals NHS Trust Board; and Vice Chair of the Lincolnshire Action Trust Board in addition to her representation on the Lincolnshire Health and Wellbeing Board as Chair of the Lincolnshire Coordinating Board. It was noted that in relation to item 6a Lincolnshire Pharmaceutical Needs Assessment 2018, the clinicians on the Board may have been involved in this process as many GPs had dispensing practices in Lincolnshire. 29 MINUTES OF THE MEETING OF THE LINCOLNSHIRE HEALTH AND WELLBEING BOARD HELD ON 5 DECEMBER 2017 That the minutes of the meeting held on 5 December 2017 be confirmed and signed by the Chairman as a correct record. 30 ACTION UPDATES FROM THE PREVIOUS MEETING That the completed actions as detailed be noted. 31 CHAIRMAN'S ANNOUNCEMENTS The Chairman referred to the announcements published within the agenda pack and also those circulated to the Board under separate cover. The Board was encouraged by the news about the Medical School in Lincolnshire and also Lincolnshire Partnership NHS Foundation Trust, which had been reported as one of the seven trusts who had made significant improvement on re-inspection by the Care Quality Commission (CQC). That the Chairman's announcements be noted. 32 DECISION/AUTHORISATION ITEMS 32a Lincolnshire Pharmaceutical Needs Assessment 2018 Consideration was given to a report by Derek Ward (Director of Public Health) which invited the Board to approve the final Pharmaceutical Needs Assessment 2018 following the consultation which took place between 11 December 2017 and 11 February 2018. Page 6
3 The Board was reminded that the completion of a Pharmaceutical Needs Assessment (PNA) was a statutory duty for Health and Wellbeing Boards to undertake at least every three years. The data contained within the assessment would be used to plan pharmaceutical services in the county which would best meet local health needs. Following the close of the consultation, a total of 18 responses had been reviewed by the Steering Group on 27 February 2018 and, as a result, some changes were made to the draft 2018 PNA. A summary of the consultation responses and report had been made available to the Board as part of the agenda pack. It was reported that the conclusions remained unchanged from the draft report approved by the Board on 5 December 2018. The Board was invited to ask questions, during which the following points were noted:- It was noted that there were no current links to engage district councils in particular but that work was planned to establish future arrangements for this; Different levels of pharmacy provision was available and it was suggested that a map showing all of these provisions would be helpful to give a fairer picture; and One member noted concern that the electronic system for ordering prescriptions online may not be as efficient in some areas. It was explained that work was ongoing to improve the process as a whole, in particular connectivity with some dispensers and pharmacies. That the final Pharmaceutical Needs Assessment (PNA) 2018 be approved for publication by 1 April 2018. 33 DISCUSSION ITEMS 33a Joint Health and Wellbeing Strategy for Lincolnshire Consideration was given to a report by David Stacey (Programme Manager Strategy and Performance) which detailed the development of the next Joint Health and Wellbeing Strategy for Lincolnshire. Since the meeting in December 2017, further work had been undertaken with each of the groups identified by the Board to discuss delivery planning; review next steps; and explore possible future engagement with relevant boards, groups, etc. Emerging areas for discussion were included within the report as noted below:- Whole System Approach to Obesity; Investment; Strategy Alignment; Further Engagement; and Page 7
4 Merge "Embed Prevention" Themes. Members were invited to ask questions, during which the following points were noted:- A discussion was encouraged around governance and the development of appropriate objectives mapped against the issues faced by Lincolnshire residents. There was core focus in parts of Lincolnshire in relation to obesity, for example, and it was suggested that joint funding would be necessary to provide an appropriate level of service; The Board agreed that the issue of obesity was concerning within Lincolnshire and that a number of initiatives would be needed to impact positively, including early intervention, education of nutrition and physical activity for the whole family to encourage and support families; Poverty also had a detrimental impact on health as this often resulted in an unhealthy lifestyle; It was asked if members of health and wellbeing boards in other areas were proactive in engaging with schools and academies and suggested that the Board could consider becoming more active in engaging with young people to encourage a healthier lifestyle; It was also suggested that provision of referral pathways to weight loss initiatives may also assist in reducing the increase in obesity. It was acknowledged, however, that this could prove difficult to implement; The physical activity element of the JHWS had been based on Sport England's strategy but the Board felt that the strategy of Active Lincolnshire should also have been linked to the JSNA; It was explained that the survey would be undertaken throughout April, following which the strategy plans would be developed and presented to the Board at its meeting in June; The Board agreed that the strategy would also provide a good opportunity to align with neighbourhood teams across the county; 1. That the further development of the Joint Health and Wellbeing Strategy be noted; 2. That further consideration of taking a 'whole system' approach to Obesity be agreed; 3. That an approach to align other strategies to the Joint Health and Wellbeing Strategy (JHWS), wherever possible, be supported; 4. That the two 'embed prevention' themes be aligned as recommended within the report; and 5. That a quick-focussed engagement exercise during April 2018 in relation to the development of the delivery plans for each priority area be supported. 33b Health and Wellbeing Board Development Session - Proposal Consideration was given to a report by Alison Christie (Programme Manager Health and Wellbeing) which asked the Board to consider holding a development workshop, Page 8
5 entitled "Stepping up to the place" facilitated by the Local Government Association (LGA) in June 2018. The Chairman advised that she had delivered some of these sessions in other parts of the country and suggested that the workshop would provide reassurance that the Board was appropriately driving the health and wellbeing agenda for the residents of Lincolnshire. Members indicated that they would be keen to hold this workshop and it was suggested and agreed to invite wider colleagues, including district council members and health colleagues. Members were asked to contact Alison Christie (Programme Manager Health and Wellbeing) with any specific suggestions for the session. It was agreed to hold the workshop on either a Wednesday or Thursday and that the date be provided well in advance of the session to enable good attendance. 1. That a workshop, facilitated by the Local Government Association, be held in June 2018; and 2. That an invitation to the workshop be extended to district council members and healthcare professionals. 33c Housing, Health and Care Delivery Group Update Consideration was given to a report from Councillor Mrs W Bowkett (Chairman of the Housing, Health and Care Delivery Group) and Lisa Loy (Housing for Independence Programme Manager) which provided an update on the activities of the Housing, Health and Care Delivery Group and the wider Housing for Independence (HfI) work. The Board was advised that the group had met three times and emphasised the importance of the group in being the strategic link for housing, health and care. Housing remained a fundamental requirement for everyone but it was acknowledged that this remained a complex issue however, despite this, major improvements had been made. The report included the recognition in the increase of cases of hoarding nationally which was, in some cases, resulting in delayed transfer of care (DToC). Lincolnshire was keen to develop a common protocol and guidance to tackle this issue and the HfI Programme Manager was coordinating this work and sought to ensure that a collaborative approach was agreed. It was suggested that a task and finish group be held in the Spring of 2018. Members were invited to ask questions, during which the following points were noted:- It was suggested that the CCGs would be the best forum to request feedback as this would include multi-disciplinary colleagues rather than GPs alone. Community Nurses would be key due to regular interaction with patients at home; Page 9
6 It was agreed that hoarding could be as a result of more complex medical issues. Lincolnshire Partnership NHS Foundation Trust had been contacted and confirmed that there was no single data point for this kind of information which would be needed in order to support people better; Work was also being done by Lincolnshire Community Health Services NHS Trust in relation to hoarding whose community nurses had undertaken a number of case studies; Discussions were ongoing with East Lindsey District Council to consider building properties which would be suitable for a range of people, including lower windows, wider doors, etc.; The Board was encouraged at how well this group was working together to drive the wellbeing agenda forward; and Members indicated that they would find it beneficial to have a specific item on a future agenda to provide details of the wellbeing service. It was agreed to add this to the forward plan. 1. That the progress to-date be noted; and 2. That an item entitled "Wellbeing Service" be added to the Forward Plan for future consideration. 34 INFORMATION ITEMS 34a Better Care Fund - Update The Board received a report by Glen Garrod (Executive Director of Adult Care and Community Wellbeing) which provided an update on the Better Care Fund (BCF) in Lincolnshire for 2017-2019 and included the submission of the BCF Narrative Plan and the related Planning Template. Steve Houchin (Head of Finance, Adult Care and Community Wellbeing) introduced the report and explained that the schemes would be considered to decide if a review would be required for those areas spending more than they should or less than they should. That the report for information be received. 34b An Action Log of Previous Decisions The Board received a report which noted the decisions taken since June 2017. That the report for information be received. Page 10
7 34c Lincolnshire Health and Wellbeing Board Forward Plan The Board considered the Forward Plan of the Lincolnshire Health and Wellbeing Board which provided members with an opportunity to discuss the items for future meeting which would, subsequently, be included on the Forward Plan. A suggestion was made to consider harnessing academic research capacity in the county, at Bishop Grosseteste University and the new medical school, at a future meeting. That the report for information be received. The meeting closed at 3.45pm Page 11
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